Not too long ago, one could not drive more than a few miles without seeing a sign or display thanking our frontline workers for their efforts in the face of the COVID-19 pandemic. A good portion of those frontline workers were nurses.
While most of our society was sheltering in place, my fellow nurses and I were seeing patients with an illness we did not fully comprehend. In the hospitals, they were working extra hours with minimal staff, overcrowded units and stretching medical supplies well beyond their intended life.
In nursing homes, despite their best efforts, my colleagues had to stand by helpless while scores of their patients succumbed to COVID. During the pandemic, I also witnessed many nurses simply walk away from the bedside out of frustration and exhaustion. Now that the tidal wave of the pandemic has passed, we must do our best to take care of those heroes who worked tirelessly and selflessly to care for us.
As a nurse with 15 years of experience across skilled nursing (nursing homes), acute care (hospitals) and homecare, I have had the privilege of caring for patients across our state and in a variety of settings/health conditions. The one thing I have noticed across all those settings is that we never seem to have enough staff.
That shortage or lack of staffing has been most apparent when I worked in skilled nursing facilities (nursing homes). According to the most recent State of Connecticut Census, we have over 24,400 nursing home beds in this state. And they hold some of our most fragile, helpless patients. In contrast, we have just 8,700 hospital beds. Our nursing home patients make up the bulk of inpatient population in the state.
As of 2021, our state required each nursing home patient to receive three hours daily of direct patient care. Prior to that it was only 1.9 hours per day and had not been updated in nearly 30 years. Direct patient care is a combination of the care provided by registered nurses (RNs), licensed practical nurses (LPNs) and certified nursing assistants (CNAs).
Three hours, combined. That’s it. To assess, provide medication, personal care, assist with dressing, feeding and the myriad of other activities necessary for the wellbeing of patients that may rely on the staff for nearly everything. A breathing treatment can take a nurse 15-20 minutes to administer alone. Some patients require three to four treatments daily. Every moment of care given to one patient lessens the care available to others.
A study completed by the Centers for Medicare & Medicaid Services in 2001 found that nursing home patients require a minimum of 4.1 hours of direct patient care. Many states have based their staffing requirements on this study and currently there is a bill (SB 989) that seeks to increase our state minimum to 4.1 hours of care daily. While is an improvement, please consider the age of this study.
I began my career in 2007. The acuity and care required for the patients admitted to skilled nursing facilities has changed greatly since then. Hospitals are discharging patients quicker and with much more complicated health issues than they ever have in the past. Even if this bill is passed, we will be basing our staffing expectations on a 20-year-old study. Our seniors deserve better. Our heroes deserve better.
Currently there is another bill gaining traction in our state, SB 1067, that will address nurse staffing levels in acute care facilities (hospitals). I support this bill, but in the push to address the staffing difficulties of acute care facilities, I implore you to not forget about those of working in skilled care facilities. We care for your parents, your grandparents and in rare cases, your children. We do so without the multidisciplinary support or resources present in acute care facilities. And currently the facilities we work in are only required to provide these patients with three hours of care per day.
That is simply not enough to adequately address even the simple medical needs of each patient. If you have any doubts, let me explain what three hours of care per day looks like. For the hours of 7-3 and 3-11, there will be one registered nurse supervisor per 128 patients, one licensed nurse per 33 patients, one CNA per 10-11 patients. Overnight on 11-7, there will only be one nursing supervisor, one unit nurse per 64 patients and one CNA per 16 patients. Please contemplate this for a moment. Our most fragile patients who are least likely able to care or advocate for themselves only receive 7.5 minutes of care every hour.
Please do not forget about us. We are here and we are working tirelessly to provide safe, compassionate care for your loved ones and for those who do not have anyone looking out for them. We need more staff, and we need it now, before we are faced with another pandemic.
A 2020 study by Harrington et al found that nurse staffing levels in skilled nursing facilities has a direct impact on patient wellbeing and medical outcomes. The same authors also found that simply measuring nursing hours per day is not enough. Staffing guidelines and expectations should be based on patient acuity and actual need.
As we have stood by you and your loved ones in your darkest hours, please stand by us and help us improve the care we give to our patients. Please support SB 989 and any further efforts to improve nurse staffing levels. You can help by writing or calling your state representative.
If you are a nurse, or if you know a nurse that has touched your life and you would like to share that story with your legislator in support of national legislation, please visit RNAction.org and click “Take Action.” You can simply enter your mailing address and your story or comment will be automatically forwarded to your representatives. It will only take a moment and could mean all the difference for the nurses and patients of our state.
Kenneth Elyosius Jr. is an RN working in a nursing home here in Connecticut. He is currently working towards his Master’s Degree at the University of Connecticut in the Family Nurse Practitioner (FNP) Program .